Insomnia in general practice: the role of doxylamine

Abstract

The general practitioner encounters all three forms of insomnia: idiopathic, chronic and acute. Idiopathic and chronic patients should receive specialized care by neurologist, psychiatrist or sleep disorders specialists because they require deep differential diagnosis and complex treatment. Acute insomnia patients need quick help to prevent the negative health impact and chronisation of sleep disruption. In theRussian Federation, the GP has access to three kinds of sleep drugs: benzodiazepines, melatonin receptor agonists, antihistamines. However, modern benzodiazepines are unavailable inRussiaand older benzodiazepines can lead to dependence. Melatonin receptor agonists are not effective enough for acute insomnia. Among available antihistamines, doxylamine is the most convenient option in clinical practice. Doxylamine has a good profile of safety and efficacy, it is included in the local clinical guidelines for insomnia. Also, doxylamine is the only sleep drug available for pregnant women. This paper presents a portrait of doxylamine and comments on its clinical niches and contraindications. We also discuss the pharmacology of doxylamine, drug interactions, and prescription modes. There are also three clinical case studies, presenting the typical acute insomnia patients and logic for their evaluation, underlining key clinical features of this disorder.